Rise of the Gap Year: Unintended Consequences of Evolving Assessment Systems

Objective Recent changes have substantially impacted the assessment of medical students, including adjustments in clerkship grading and the transition of Step 1 to a pass/fail grading system in 2022. This study examines factors influencing students’ decisions to take a gap year and the potential impact of assessment changes on the landscape of these decisions. Design This qualitative study used semi-structured interviews of medical students applying to surgical specialties to gather in-depth perspectives regarding their decision-making processes around taking or not taking a gap year. Setting We conducted virtual interviews with students from 5 U.S. medical schools located in the West, Midwest, Mid-Atlantic, and South. Participants Interviewees comprised 25 senior medical students pursuing surgical specialties including general surgery, orthopedic surgery, neurosurgery, plastic surgery, and otolaryngology–head and neck surgery. Results We identified 5 main themes related to students’ gap year decisions. Local institutional and specialty cultures set background expectations around gap years. Within these contexts, 3 dominant and often interrelated reasons motivated gap year decisions: the anticipated potential of a gap year to affect residency application competitiveness; personal, nonacademic circumstances; and the desire for professional growth. Regardless of students’ gap year wishes, logistics ultimately dictated decisions for many students. Conclusions In the context of evolving assessment systems, residency application competitiveness emerged as a primary factor influencing students’ decisions to take a gap year. Students described that the transition of Step 1 to pass/fail led to fewer objective application metrics, with an ensuing focus on increased research productivity as a perceived differentiating factor amongst applicants. Personal and professional growth motivations remained present, but often played secondary roles in decision-making. For both gap year and traditional students, concerns regarding research years included variable access to funding, financial and temporal costs, and implications for delayed career and family timelines.